Myosteatosis is one of the common complications in patients with end-stage liver disease, which is significantly associated with poor outcomes after liver transplantation. Currently, diagnostic criteria of myosteatosis have not been established, and CT is the most commonly used for diagnosis. The pathogenesis of myosteatosis is multifactorial, and the pathophysiological mechanisms linking it to end-stage liver disease are not fully understood. An increasing number of scholars have recognized that the severity of myosteatosis is closely related to its clinical consequences, but there are no effective treatment options available. This article reviews the pathophysiological mechanisms and diagnostic methods of myosteatosis, and its impact on the prognosis of liver transplant recipients, and discusses current treatment strategies to provide references for the perioperative management of liver transplant recipients.

With the continuous progress of modern science and technology, the research of TCM inspection is gradually moving towards a new stage of objectification and intelligence. By systematically sorting out the key technologies involved in the objectification of inspection and diagnosis, and summarizing its clinical application progress in the three core areas of face diagnosis, tongue diagnosis and visual diagnosis, it is found that the inspection and diagnosis of TCM can not only significantly improve the efficiency and accuracy of clinical diagnosis with the help of modern technology, but also achieve more results in disease differentiation, constitution identification and efficacy evaluation. The key technologies include digital image processing, infrared thermal imaging, spectroscopy, photoelectric volume and artificial intelligence (AI) technology. In terms of clinical application, facial diagnosis focuses on image and infrared thermography feature analysis, tongue diagnosis involves image, spectral feature research and AI model construction, and eye diagnosis focuses on white eye collaterals extraction, fundus sign analysis and eye movement information research. However, there are still some problems, such as imperfect standardization system, bottleneck of multi-modal fusion and interpretation, insufficient clinical verification and practicability. In the future, the deep integration of TCM observation and modern science and technology should be promoted by means of technological integration and innovation and strengthening interdisciplinary cooperation, so as to help the modernization of TCM diagnosis.

Objective:To investigate the feasibility of stapled closure of the internal fistula orifice in anal fistula (SCIA) combined with catheter drainage in the extra-sphincteric space in the treatment of high complex anal fistula.Methods:Methods Surgical procedure: Under combined spinal-epidural anesthesia, a submucosal purse-string suture was placed above the dentate line, and the stapler was inserted to close the internal opening. The fistulous tract was dissected from the external opening toward the cranial side and excised along its path to the level of the levator ani muscle, followed by placement of catheter drainage in the extra-sphincteric space.Results:A retrospective analysis was conducted on the clinical data of a 40-year-old male patient with a high-position complex anal fistula, who underwent SCIA combined with catheter drainage in the extra-sphincteric space at the Department of Colorectal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine in December 2024. The surgery was successful with minimal intraoperative bleeding, a complete anastomosis, and thorough fistula tract dissection. There was no sphincter injury occurred, and the catheter drainage was unobstructed. The patient was discharged on postoperative day 8. Postoperative follow-up visits were conducted at 2 months and 6 months after surgery. The patient had no symptoms such as pain, purulent discharge, or pruritus. MRI scans of the anal canal (both plain and contrast-enhanced) at 2 months and 6 months showed no recurrence of the fistula. The Wexner fecal incontinence score was 0, indicating normal bowel control, and the Garg score was less than 8, suggesting fistula healing and low probability of recurrence.Conclusion:SCIA combined with catheter drainage in the extra-sphincteric space is a safe and feasible procedure for the treatment of high complex anal fistula.

Objective:To investigate the feasibility of stapled closure of the internal fistula orifice in anal fistula (SCIA) combined with catheter drainage in the extra-sphincteric space in the treatment of high complex anal fistula.Methods:Methods Surgical procedure: Under combined spinal-epidural anesthesia, a submucosal purse-string suture was placed above the dentate line, and the stapler was inserted to close the internal opening. The fistulous tract was dissected from the external opening toward the cranial side and excised along its path to the level of the levator ani muscle, followed by placement of catheter drainage in the extra-sphincteric space.Results:A retrospective analysis was conducted on the clinical data of a 40-year-old male patient with a high-position complex anal fistula, who underwent SCIA combined with catheter drainage in the extra-sphincteric space at the Department of Colorectal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine in December 2024. The surgery was successful with minimal intraoperative bleeding, a complete anastomosis, and thorough fistula tract dissection. There was no sphincter injury occurred, and the catheter drainage was unobstructed. The patient was discharged on postoperative day 8. Postoperative follow-up visits were conducted at 2 months and 6 months after surgery. The patient had no symptoms such as pain, purulent discharge, or pruritus. MRI scans of the anal canal (both plain and contrast-enhanced) at 2 months and 6 months showed no recurrence of the fistula. The Wexner fecal incontinence score was 0, indicating normal bowel control, and the Garg score was less than 8, suggesting fistula healing and low probability of recurrence.Conclusion:SCIA combined with catheter drainage in the extra-sphincteric space is a safe and feasible procedure for the treatment of high complex anal fistula.

Objective:To construct a double-closed-loop management model for medical equipment and explore its application value in hemodialysis machine maintenance and fault management.Methods:Based on the closed-loop management of clinical operation of medical equipment and the closed-loop management of technical support,a dual closed-loop management model of equipment was constructed.65 hemodialysis machines in clinical use in Huashan Hospital Fudan University from January 2021 to January 2023 were selected and divided into a conventional mode and double-closed-loop mode according to different management modes.The conventional mode adopted conventional equipment management methods,and the double-closed-loop mode adopted a double-closed-loop management model.The cost-effectiveness,social benefit,failure occurrence,effective management quality matters,disinfection status,average patient waiting time and satisfaction were compared between the two groups.Results:The hemodialysis machine operating profit growth rate,diagnosis and treatment cost growth rate,service life index,scientific research service growth rate,diagnosis and treatment service growth rate,startup rate and operation rate of the double-closed-loop mode were(3.95±1.04)%,(3.80±0.58)%,(1.58±0.31)%,(4.30±0.95)%,(7.91±1.58)%,(96.58±2.76)%and(89.90±5.58)%,which were higher than those of the Conventional mode,the difference was statistically significant(t=5.418,10.070,7.490,17.570,11.820,8.849,6.840,P<0.05).The technical support expenses growth rate,bacterial colony count,bacterial endotoxin content and average patient waiting time of patients in the Double-closed-loop mode were(2.60±0.33)%,(0.370±0.008)cfu/ml,(0.0063±0.0011)EU/ml and(0.76±0.13)h,which were less than those of the conventional mode,the difference was statistically significant(t=23.040,82.985,14.482,19.530,P<0.05).The incidence rate of hemodialysis machine failure in the double-closed-loop mode was 9.23%(6/65),which was lower than that in the conventional mode,the difference was statistically significant(x2=6.392,P<0.05);among the 120 items of management data collected,quality control testing,maintenance and repair,clinical operation,information data,and scrap processing effectiveness rates were 95.83%(115/120),89.17%(107/120),96.67%(116/120),95.00%(114/120),and 97.50%(117/120),respectively,which were higher than those of the conventional mode,the difference was statistically significant(x2=15.238,16.596,9.808,15.585,16.119,P<0.05).Conclusion:The application of closed-loop management model to hemodialysis machine maintenance and fault management can effectively improve equipment cost-effectiveness,social benefits,management quality and patient satisfaction,and reduce the incidence of faults.

Objective:To explore the risk factors for malnutrition after a tracheotomy and to construct a predictive model useful for its prevention through early intervention.Methods:Clinical data describing 440 tracheotomy patients were subjected to a retrospective analysis. The variables examined were age, sex, etiology, Glasgow Coma Score (GCS), activities of daily living (ADL) score, age-corrected Charlson comorbidity index (aCCI), food intake, swallowing function, incidence of infections, as well as any history of diabetes mellitus, hypertension, smoking or alcohol consumption. Patients identified as being at risk of malnutrition (NRS-2002≥3) were screened using the Nutritional Risk Screening tool (NRS-2002) and the European Society of Clinical Nutrition and Metabolism′s ESPEN2015 criteria. The subjects were thus categorized into a malnutrition group of 343 and a control group of 97. Unifactorial and multifactorial logistic regression analyses were performed, and stepwise regression was applied to include the factors found significant in the unifactorial analysis into the multifactorial logistic regression analysis, and to construct a column-line graph prediction model. The clinical utility of the model was assessed by applying the receiver operator characteristics (ROC) curves, calibration plots and decision curve analysis (DCA).Results:Of the 440 persons studied, 343 (78%) were malnourished. The multivariate logistic regression analysis showed that pulmonary infection, dysphagia, low GCS score and high aCCI score were significant risk factors for malnutrition after a tracheotomy. A prediction nomograph was constructed. After fitting and correcting, the area under the curve (AUC) of the prediction model′s ROC curve was 0.911, the specificity was 80.4%, and the sensitivity was 91.3%. That was significantly higher than the AUCs for pulmonary infection (0.809), dysphagia (0.697), aCCI (0.721) and GCS (0.802). Bootstrap self-sampling was used to verify the model internally. After 1000 samples the average absolute error between the predicted risk and the actual risk was 0.013, indicating good prediction ability. The DCA results demonstrated that the model has substantial clinical applicability across a range of nutritional interventions, particularly for threshold probability values ranging from 0 to 0.96.Conclusion:Pulmonary infection, dysphagia, low GCS score, and high aCCI score are risk factors for malnutrition among tracheotomy patients. The nomogram model constructed in this study has good predictive value for the occurrence of malnutrition among such patients.

Objective:To evaluate the effects of low-dose esketamine on postoperative pain and depression degree in patients undergoing radical surgery for colorectal cancer.Methods:A prospective randomized controlled study was conducted. Eighty-four patients who plan to undergo elective radical resection for colorectal cancer at Shanxi Province Cancer Hospital from December 2023 to March 2024 were divided into esketamine group (observation group) and 0.9% NaCl solution group (control group) using the random number table method, with 42 patients in each group. The observation group was given intravenous infusion of 0.25 mg/kg esketamine 30 minutes before anesthesia induction and 30 minutes before the end of surgery, while the control group was given intravenous infusion of the equal dose of 0.9% NaCl solution. The remaining anesthesia methods were the same for both groups. The postoperative pain number rating scale (NRS) scores, Ramsay sedation score and perioperative dosages of sufentanil, remifentanil and propofol were compared between the two groups. The Hamilton depression rating scale (HAMD) score was used to evaluate the degree of depression before and after surgery in two groups of patients and the score was compared between the two groups.Results:Two cases were discharged from the observation group and two cases were discharged from the control group due to postoperative catheterization and return to the intensive care unit. There were no statistically significant differences in gender, age, body mass index, anesthesia time, recovery time, extubation time, intraoperative fluid replacement volume, and fluid output between the two groups of patients (all P > 0.05). The dosage of remifentanil in the observation group was lower than that in the control group [(481±117) mg vs. (718±161) mg], and the difference was statistically significant ( t = 7.52, P < 0.001). The NRS scores of the observation group were lower than those of the control group at 1 and 2 hours after surgery, and the differences were statistically significant (both P < 0.001). The perioperative salvage analgesia rate in the observation group was lower than that in the control group [12.5% (5/40) vs. 32.5% (13/40)], and the difference was statistically significant ( χ2 = 4.59, P = 0.032). The Ramsay sedation scores of the observation group were higher than those of the control group at 1, 2, and 4 hours after surgery, and the differences were statistically significant (all P < 0.001). The HAMD scores of the observation group at 3 and 7 days after surgery were lower than those before surgery, and both were lower than those of the control group, and the differences were statistically significant (all P < 0.05). Conclusions:Low-dose esketamine used in radical surgery for colorectal cancer can not only effectively reduce perioperative pain and improve sedative effects, but also alleviate patients' depression and improve the quality and speed of postoperative recovery.

Objective:To evaluate the effects of low-dose esketamine on postoperative pain and depression degree in patients undergoing radical surgery for colorectal cancer.Methods:A prospective randomized controlled study was conducted. Eighty-four patients who plan to undergo elective radical resection for colorectal cancer at Shanxi Province Cancer Hospital from December 2023 to March 2024 were divided into esketamine group (observation group) and 0.9% NaCl solution group (control group) using the random number table method, with 42 patients in each group. The observation group was given intravenous infusion of 0.25 mg/kg esketamine 30 minutes before anesthesia induction and 30 minutes before the end of surgery, while the control group was given intravenous infusion of the equal dose of 0.9% NaCl solution. The remaining anesthesia methods were the same for both groups. The postoperative pain number rating scale (NRS) scores, Ramsay sedation score and perioperative dosages of sufentanil, remifentanil and propofol were compared between the two groups. The Hamilton depression rating scale (HAMD) score was used to evaluate the degree of depression before and after surgery in two groups of patients and the score was compared between the two groups.Results:Two cases were discharged from the observation group and two cases were discharged from the control group due to postoperative catheterization and return to the intensive care unit. There were no statistically significant differences in gender, age, body mass index, anesthesia time, recovery time, extubation time, intraoperative fluid replacement volume, and fluid output between the two groups of patients (all P > 0.05). The dosage of remifentanil in the observation group was lower than that in the control group [(481±117) mg vs. (718±161) mg], and the difference was statistically significant ( t = 7.52, P < 0.001). The NRS scores of the observation group were lower than those of the control group at 1 and 2 hours after surgery, and the differences were statistically significant (both P < 0.001). The perioperative salvage analgesia rate in the observation group was lower than that in the control group [12.5% (5/40) vs. 32.5% (13/40)], and the difference was statistically significant ( χ2 = 4.59, P = 0.032). The Ramsay sedation scores of the observation group were higher than those of the control group at 1, 2, and 4 hours after surgery, and the differences were statistically significant (all P < 0.001). The HAMD scores of the observation group at 3 and 7 days after surgery were lower than those before surgery, and both were lower than those of the control group, and the differences were statistically significant (all P < 0.05). Conclusions:Low-dose esketamine used in radical surgery for colorectal cancer can not only effectively reduce perioperative pain and improve sedative effects, but also alleviate patients' depression and improve the quality and speed of postoperative recovery.

Objective:To summarize the clinical characteristics of neonatal late-onset sepsis (LOS) caused by Leclercia adecarboxylata, and provide evidence for its diagnosis and treatment. Methods:We report a case of Leclercia adecarboxylata induced LOS in a male preterm neonate diagnosed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) at the Affiliated Suzhou Hospital of Nanjing Medical University. Relavant literature was retrieved from Wanfang, VIP, CNKI, and PubMed databases up to April 2021, using terms including "neonate" "sepsis" and " Leclercia adecarboxylata". Results:The patient presented with dyspnea immediately after birth with gestational age of 34 +3 weeks and birth weight of 2 050 g. After admission at 14 min after birth, he was incubated at temperature of 33-35 ℃ and humidity of 50%-60% and received active treatment, consisting of nasal continuous positive airway pressure, tracheal intubation, intratracheal injection of pulmonary surfactant, invasive mechanical ventilation, and anti-infective treatment with piperacillin, cefoperazone/sulbactam, and meropenem. However, the patient developed LOS on day 11 of life and eventually died of disseminated intravascular coagulation and multiple organs failure despite volume expansion, anti-infective therapy, and respiratory support. The blood culture was positive for Gram-negative rod and confirmed as a multi-drug resistant strain of Leclercia adecarboxylata. Two cases of LOS caused by sensitive strain of Leclercia adecarboxylata in premature female infants were retrieved in the literature with atypical symptoms, of whom one was successfully treated and one died after active treatment. Conclusions:Leclercia adecarboxylata infection alone can lead to LOS in preterm infants without typical manifestations. MALDI-TOF MS is helpful for the diagnosis and rational application of antibiotics.

Objective:To study the changes of plasma receptor interacting protein 3 (RIP3) levels in neonatal late-onset sepsis (LOS) and to determine its clinical value.Methods:From October 2019 to April 2021, plasma samples and clinical data of LOS infants admitted to our hospital were prospectively studied. Infants with similar gestational ages admitted for non-infectious diseases were assigned into the control group. Enzyme-linked immunoassay was used to determine plasma RIP3 levels. The clinical value of plasma RIP3 in the diagnosis and treatment of neonatal LOS were analyzed.Results:A total of 152 cases (76 in the LOS group and 76 in the control group) were included in the study. No significant differences existed in the baseline data between the two groups. A total of 226 plasma samples were collected (76 samples from the LOS group before treatment, 74 samples after treatment and 76 samples from the control group). The plasma RIP3 level of LOS group before treatment (19.9±6.3 ng/ml) was significantly higher than the control group (11.4±3.5 ng/ml) and the after treatment group (11.9±3.5 ng/ml) ( P<0.05). The plasma RIP3 level had good diagnostic value for neonatal LOS (AUC=0.884). With cut-off value of 15.5 ng/ml, the plasma RIP3 showed the best diagnostic efficacy (Youden index 0.658, sensitivity 72.4%, specificity 93.4%, positive likelihood ratio 11.0, negative likelihood ratio 0.3). Conclusions:Plasma RIP3 level is closely related with neonatal LOS and may be used for the early diagnosis and therapeutic evaluation of neonatal LOS.